Bill > HB3445

This bill amends the Illinois Insurance Code to modify provisions related to recoupments, which are financial adjustments made by insurers or healthcare organizations to recover previously paid funds. The bill requires that when a recoupment occurs, the remittance advice must include specific details such as patient name, service date, service description, recoupment amount, and reason for the recoupment. Insurers must also provide a contact method and deadline for appealing the recoupment, which must be done within 60 days of receipt. The bill changes the time limit for recoupments from 18 months to 12 months after the original payment, with exceptions for cases involving fraud, formal findings by a court or administrative agency, specific insurance plan administration, duplicate payments, or Medicaid-related recoupments. The bill maintains protections for healthcare professionals and providers by ensuring transparency in the recoupment process and limiting the timeframe in which insurers can request repayment. The changes will take effect on January 1, 2026, providing healthcare organizations and insurers time to adjust their processes to comply with the new requirements.

Business and Industry

https://www.ilga.gov/legislation/BillStatus.asp?DocNum=3445&GAID=18&DocTypeID=HB&SessionID=114&GA=104